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De Quervain’s Tenosynovitis
Understanding the causes, symptoms and treatment options for De Quervain’s tenosynovitis, a common cause of pain on the thumb side of the wrist.
What is it?
De Quervain’s tenosynovitis describes irritation and swelling of the two tendons that run along the thumb side of the wrist, within a narrow tunnel called the first dorsal compartment. When these tendons become irritated and the surrounding lining thickens, movement of the thumb and wrist becomes painful, particularly with gripping, twisting or lifting.
At a glance
What is it?
Irritation of the tendons on the thumb side of the wrist as they pass through a narrow tunnel
Common symptoms
Pain and swelling on the thumb side of the wrist, worse with gripping, twisting or lifting
Who it affects
Including but not limited to: new parents lifting a baby, people doing repetitive thumb or wrist movements, and pregnant or postpartum women
Is it serious?
Not dangerous, but can be persistently painful and limit hand use if untreated
Treatment options
Splinting, activity changes, corticosteroid injection, or surgery
First step
Hand therapy management, a corticosteroid injection administered under ultrasound guidance by a radiologist, then if symptoms persist a consultation and examination to confirm the diagnosis
Causes and risk factors
- Repetitive thumb or wrist movements
- Lifting and carrying a baby, especially with the thumb outstretched
- Racquet sports or golf
- Pregnancy and the postpartum period
- A direct injury to the wrist
Symptoms and how de Quervain's tenosynovitis presents
The main symptom is pain and swelling on the thumb side of the wrist, which is worse with gripping, twisting the wrist, or lifting objects. Some people notice a catching or grating sensation with thumb movement, and the pain can radiate up the forearm or into the thumb.
How is de Quervain's tenosynovitis diagnosed?
De Quervain’s is usually diagnosed from your history and an examination, including Finkelstein’s test, where bending the thumb into the palm and tilting the wrist towards the little finger reproduces the pain. Imaging can be used to confirm the diagnosis.
Treatment options for de Quervain's tenosynovitis
Mild to moderate symptoms are often helped by wearing a thumb splint and avoiding the movements that bring on pain. A corticosteroid injection into the tendon tunnel is often very effective and is best administered by a radiologist under ultrasound guidance.
If symptoms persist despite these measures, surgery to release the tight tunnel around the tendons is usually recommended. This is a common day procedure.
When to see a hand surgeon about de Quervain's tenosynovitis
It is worth seeing a hand surgeon if you have persistent pain on the thumb side of the wrist that is not settling with rest and simple splinting under the guidance of a hand therapist.
What to expect at your appointment
At your appointment, Dr Tomlinson will take a history of your symptoms and examine your wrist and thumb, including Finkelstein’s test. Together you will discuss the treatment options that suit your situation.
Frequently Asked Questions
What is De Quervain's tenosynovitis?
Irritation and swelling of the two tendons that run along the thumb side of the wrist, within a narrow tunnel called the first dorsal compartment, causing pain with thumb and wrist movement, particularly gripping, twisting or lifting.
What causes it?
Repetitive thumb or wrist movements, lifting and carrying a baby, especially with the thumb outstretched, racquet sports or golf, pregnancy and the postpartum period, and a direct injury to the wrist can all contribute.
What can I do myself?
Wearing a thumb splint and avoiding the movements that bring on pain can help mild to moderate symptoms.
What can a hand therapist do?
Provide and fit a thumb splint, advise on activity changes, and support your recovery with therapy if you have surgery.
What can a hand surgeon do?
Confirm the diagnosis on examination, including Finkelstein’s test, and can refer you for a corticosteroid injection into the tendon tunnel under ultrasound guidance, which is often very effective. If symptoms persist despite these measures, surgery to release the tight tunnel around the tendons is usually recommended, a common day procedure.
What can I expect from treatment?
Splinting and activity changes settle many mild cases. A corticosteroid injection is often very effective, sometimes for months at a time. Surgical release is a well-established day procedure aimed at relieving pressure on the irritated tendons.
What happens if it's left untreated?
Symptoms can persist and continue to limit gripping, lifting and thumb movement. Earlier assessment gives more treatment options before symptoms become more entrenched.
Related conditions and treatments
De Quervain’s tenosynovitis affects a tendon tunnel at the wrist, which is different from thumb base osteoarthritis, a joint condition that also causes pain near the base of the thumb. It is also distinct from trigger thumb, which involves catching rather than pain with gripping.